Ignorance is not bliss. Guys, if you have a woman in your life who you care about, please read on. Ladies, if you don’t know that cardiovascular disease is your greatest health threat, killing more women than all forms of cancer combined, please also read on.
The inspiration for this column came from a short piece recently aired on CBC’s The National titled, “What women need to know about heart disease.” The segment began with this voice over: “A woman in Canada dies of heart disease every 22 minutes, and most don’t have to,” while “Canadian women remain under-diagnosed for heart disease,” scrolled along the bottom of the screen.
It was not a bland piece about eating correctly and exercising. Instead, the story indicated that we in Canada are surprisingly ignorant of the different risk factors, symptom presentation and variety of cardiovascular diseases that afflict women. The report also claimed that women experience bias within our healthcare system in the diagnosis and post-incident care of heart health problems.
The Heart & Stroke Foundation of Canada concurs, and reports, “Women’s experience with heart disease is different from men’s in several important ways. Women are under-aware and under-researched. Within the healthcare system they are under-diagnosed and under-treated, and under-supported in their recovery.”
Was this accurate, and what more do we need to know?
We’re all taught to recognize that an excruciating pain in the chest is likely a heart attack. This most common heart attack symptom is the same for men and women —severe chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes. Yet in many situations women having heart attacks don’t reflect this classic presentation or intensity, and compared to men, women’s symptoms occur more often when they are resting or asleep.
Common female symptoms include pain in one or both arms, neck, jaw, shoulder, upper back and abdominal discomfort, and unusual fatigue. Shortness of breath, lightheadedness, dizziness, sweating and indigestion as well as nausea and vomiting may all signal a cardiovascular issue which is frequently ignored or confused with another problem when suffered by a woman. Only 44 percent of American women recognize cardiovascular disease as the number one threat to their health.
Three traditional risk factors for coronary artery disease are common to both men and women: high cholesterol, high blood pressure and obesity. Research suggests additional and different factors also play an important role in women’s heart disease, but more needs to be known.
Diabetic women are more likely to develop heart issues than men with diabetes. Diabetes affects the way women feel pain, increasing the risk that these women may miss a symptom or even have a “silent” heart attack. The effects of diabetes on women’s heart health is so significant that it cancels out the positive benefits of extra estrogen in pre-menopausal women, making a diabetic female’s risk of heart attack equal to men of the same age.
The additional estrogen produced by younger women helps keep blood pressure and blood triglycerides (lipid fat) low, reduces LDL (bad) cholesterol, increases HDL (helpful) cholesterol, and promotes blood clotting. As expected, when estrogen levels decline during and after menopause, this balance changes. Blood pressure, triglyceride and LDL cholesterol levels all begin to increase, while heart-helpful HDL decreases. As adipose visceral (central) fat increases, the possibility of blood clots and blood sugar problems rise, making regular blood testing critical for women at this age.
Pregnancy complications may signal the first, and very early, time that women face a gender-based increased risk for heart disease
Pregnancy complications may signal the first, and very early, time that women face a gender-based increased risk for heart disease. The American Heart Association (AHA) claims that cardiovascular disease is the number one cause of death for new moms, and is responsible for more than one third of all maternal deaths. They have also stated that high blood pressure, pre-eclampsia and gestational diabetes which occur during pregnancy increase a woman’s risk of developing cardiovascular disease in the future.
Pre-eclampsia is a unique type of high blood pressure that can occur at approximately the 20th week of pregnancy and results in kidney proteinuria, decreased blood platelets and increased liver enzymes. As well as being an immediate threat, these complications have been proven to produce a lasting negative effect on female heart and blood vessel health.
Pregnancy hormones interfere with the body’s ability to process insulin efficiently, so pregnant mothers must produce additional insulin. If the body is unsuccessful at this, blood sugar levels may rise causing gestational diabetes, which studies have shown increases the risk to both mother and baby of developing diabetes, a significant risk factor for heart disease, in later life.
Research suggests that emotional stress and depression affect women’s heart health more than men’s. As well as being causal, fighting depression may make it more difficult for women to follow lifestyle and treatment suggestions that could reduce their risk factor.
We are learning that smoking, a sedentary lifestyle, and a family history of early heart disease indicate a larger risk factor in women than men for heart disease. Unfortunately, with so much to learn about women’s heart health, the AHA says that only 38 percent of participants in clinical cardiovascular trials are female.
Many of us have female family or friends that can share stories of having difficulty getting a proper diagnosis of a heart condition in a timely manner compared to men. As mentioned, women’s symptoms present differently. Research concludes that women also have a variety of different types of heart attack, and experience them differently than men, which results in less frequent and less accurate initial diagnosis.
Women are more likely than men to have blockages in the smaller arteries that supply blood to the heart rather than just their main arteries. This condition is called coronary microvascular disease or small vessel heart disease, and presents through weak or vague symptoms that are sometimes difficult to diagnose.
Women are more prone than men to non-obstructive coronary artery disease, which can cause heart attacks and strokes without severe arterial blockage. In both microvascular and non-obstructive coronary disease, traditional angiograms are ineffective diagnostic tools, and stress tests are less sensitive to symptoms in women than men.
Spontaneous coronary artery dissection (SCAD) causes only a small percentage of heart attacks overall, but the American Heart Association claims that 90 percent occur in women. Further confusing the diagnosis of this variety of heart issue is the fact that it afflicts young and generally healthy females. The average age of a SCAD patient is 42 years old, and SCAD heart attacks represent 40 percent of all those in women younger than 50.
Atypically, SCAD is not caused by clots or plaque, but by a tear or bleed in an arterial wall which disrupts the flow of blood to the heart. Although SCAD heart attacks in women present with commonly recognized symptoms, the women seldom show typical risk factors such as smoking, obesity or diabetes. The AHA says that because of this, SCAD cases are “often misdiagnosed as problems like anxiety or indigestion, leading to treatments that may cause more damage.”
Under-treated and under-supported
The Mayo Clinic, a famous international healthcare provider, has found that female heart patients referred to them are less likely than men to have been treated with statins or aspirin to prevent future heart attacks. They encourage women to seek the guidance of their physicians and use medications for high blood pressure, high blood cholesterol and diabetes as prescribed to reduce the risk of heart disease and stroke.
Women are less likely to have been referred for cardiac rehabilitation than men, and of those that are, they are only half as likely as men to attend sessions after a heart attack. Rehabilitation treatments are proven to improve functional ability and quality of life.
Sadly, a survey by the AHA also found that women were often less likely to receive bystander CPR after a heart attack because rescuers frequently fear accusations of inappropriate touching or sexual assault, and worry about injuring the victim.
Prior to viewing the CBC report, gender equality and heart health would not have been linked on my personal radar. Having done the research to gain more insight and prepare this column, I have no doubt that women can benefit from acquiring more knowledge of heart disease, its causes and treatments, and how important it is to self-advocate when you have heart health concerns.